Thyroid & Autoimmunity
10th Mar, 2022


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Wendy McLean (00:06): Welcome to Common Ground a podcast series discussing new research and interesting projects in the field of complementary medicine. Hello, my name is Wendy McLean, Educator at is a digital platform, a professional health resource and a distribution service all in one.

Firstly, I'd like to begin by acknowledging the Gadigal people of the Eora nation as the traditional custodians on the land in which we gather here. I would also like to pay my respect to their elders both past, present, and emerging.

Thyroid disorders are some of the most common health conditions reported worldwide. The prevalence of these disorders such as an over or underactive thyroid is increasing. And in Australia, an estimated 850,000 people live with a thyroid issue. Many underlying factors may contribute to these disorders; things such as nutrition, genetics, environmental factors, also immune dysfunction, and autoimmunity.

In this episode, naturopath Emma Drady shares her clinical insights on thyroid disorders, including their clinical presentation, how to test for them and therapeutic interventions for supporting thyroid health.

Emma is a degree qualified naturopath based on the Central Coast of New South Wales. She has a passion for supporting women and focuses on treating thyroid conditions, menstrual cycle health, fertility, and menopausal symptoms. Her interest in these topics developed due to a family and personal history and the search for helping those closest to her.

We warmly welcome Emma to Common Ground today.

Emma Drady (01:43): Thanks Wendy. Thanks so much for having me here today.

Wendy McLean (01:47): So to start off, what are the different thyroid disorders that you see in your clinical practice and what are the common signs and symptoms that you see that are associated with these?

Emma Drady (01:59): So by far the most common that I see in my clinical practice is hypothyroid or underactive thyroid. That's more often than not due to Hashimoto’s and that's the autoimmune condition associated with slowing down thyroid function. So the main symptoms with this, with the underactive thyroid, the first one would be putting on weight or, or having difficulty losing weight, even though the patient might be eating really well, they might be exercising. The weight just doesn't seem to budge, or it's really slowly creeping up. That's kind of like the first thing that sort of sparks my interest to think it might be thyroid. And these people will also often feel really fatigued and sometimes it can be quite debilitating. They might also feel cold a lot of the time, although I have to say with some people they might be also going through perimenopause.

Emma Drady (03:05): So this might throw this kind of diagnosis off a little bit because they might be feeling really hot and having hot flushes. So not everyone with an underactive thyroid will feel cold, but those outside of the sort of perimenopausal and menopausal ages, they might, they might be quite cold a lot. They might also have reduced appetite. They might see thinning of the hair, which is usually on the head. And also the, the eyebrows. So you might see them being quite short especially on the outer edges. So they might have that sort of like wispy, fluffy kind of hair. And yeah, another major symptom is brain fog. So that's probably one of the biggest clues with the underactive thyroid. And that's often associated with the autoimmune presentations. So really with that underactive thyroid, they'll see just everything's really sluggish, everything slows down. So their thyroid slows down, their metabolism slows down. Their digestion might also slow down. So constipation that's another big one. So yeah, everything just feels really, really sluggish.

And then I guess, conversely with the overactive or the hyperthyroid conditions, they experience the total opposite. So they might be losing weight and they might be losing weight rapidly, or they might just be having trouble putting, putting weight on. These people will often feel really anxious, and they might have that racing heart. They might feel jumpy. They can't concentrate on their thoughts. Their sort of thoughts are just going all over the place. They might also feel like they can constantly eat. They're really different to the underactive thyroid, where they have a bit of a reduced appetite and everything's kind of slowed down.  With the overactive they tend to speed up and they can eat and eat, but not put on any weight.

Emma Drady (05:00):

I don't see it very often, but some people can also get that sort of wide eyed, bulgy kind of eye look. But that's usually a bit further down, it's, it's a bit more of a later progressive sort of symptom. Oh, and of course with the overactive, insomnia is a really big one as well. So these people will often really struggle to sleep. And they'll just be up with this racing heart, and this anxiety and just go, go, go all the time. So they're really opposite; the over and the underactive. And most of these patients will be either Graves or Hashimoto’s.

Wendy McLean (05:39): I see. And do you see any menstrual cycle disturbances in either of those conditions?

Emma Drady (05:46): I do. Yeah. So a lot of the time the menstrual cycle can be affected. So you might see heavy periods particularly. You might see a lot of pain as well. And so those kinds of symptoms often prompt me to do some thyroid testing as well. But like I was mentioning before with, with the link often with menopause and perimenopause it can be a bit tricky with that, sometimes because that's another symptom that kind of overlaps between the two.

Wendy McLean (06:21): Yeah, yeah. Very, very complex. And so you mentioned that Hashimoto’s is an autoimmune thyroid condition. So how common are the autoimmune thyroid disorders and what are the known causes or risk factors for these?

Emma Drady (06:41): So currently in Australia, Hashimoto’s is the most common cause of an underactive thyroid. And Graves is the most common cause of an overactive thyroid. So unfortunately they're both really common. I was going to try and find numbers for you, but I had a good think about it. And from my experience, a lot of people actually go undiagnosed for quite a long time. So I don't know if numbers are actually that accurate for either of these conditions. That's just my personal experience that a lot of people come to me and don't realise they have either of the two until we do the further testing. But what we do know is that thyroid conditions affect 10 times more women than they do men. So really just being born a female puts us at a greater risk, which is a bit of a shame.

And thyroid function, it also changes during pregnancy. So the thyroid will often speed up to support the thyroid function of the baby. And this means that you're creating more hormones, but a lot of women will actually see a drop off in their final trimester or even postpartum. And that's usually because of nutrient deficiencies and depletion. So that sort of particular part of the pregnancy leads to a lot of that sort of nutritional lacking and that will prompt the thyroid to slow down.

Oestrogen levels can also affect the thyroid. So like I was sort of saying before, it's really common to see changes around menopause and that's what makes it so tricky to diagnose because a lot of women will just think I'm going through menopause. All of these symptoms are just age related or, you know, sex hormone related, but really they've had this thyroid condition underlying this whole time. So it can be a bit of a tricky and delay diagnosis for a lot of these people.

And then of course, a family history of autoimmune conditions or if the patient has another autoimmune condition, such as, you know, coeliacs or rheumatoid arthritis, they're at a much high risk of developing either Hashimoto’s or Graves. And then like all other autoimmune conditions, really the exposure to things like radiation, cigarettes, heavy metals and toxins that, that really increases the risk too.

Wendy McLean (09:11): Yeah. And is vitamin D deficiency, is that related to it as well?

Emma Drady (09:16): Yeah, so there's a lot of nutrient deficiencies that can lead to thyroid issues. So iodine, selenium, vitamin D yeah, there's a lot of, of nutrients that play into thyroid conditions because the thyroid uses so much just for its function every day. So when we are low that can really affect the way that it's functioning.

Wendy McLean (09:40): Yeah, absolutely. And so you mentioned it can be quite tricky to make a diagnosis, but what are some of the common tests that you would use to try and tease out whether it's a thyroid dysfunction or menopause or perimenopause and how would we distinguish between say an autoimmune thyroid disorder as opposed to another kind?

Emma Drady (10:02): Yeah. So this is an area that I'm really quite passionate about because more often than not, I see people will go to their GP and maybe asked to have their thyroid test or they've, mentioned a few symptoms that we've sort of spoken about just before and their doctor said, oh, let's have a look at your thyroid, but they'll often just look at TSH through a blood test. And TSH stands for thyroid stimulating hormone. So this hormone is not actually made in the thyroid. It’s actually sent down on from the brain to stimulate the thyroid to make thyroid hormones. And it will send out more TSH if the thyroid is not making enough hormones. So that's why you'll see an elevated TSH in an underactive thyroid. The problem with just testing the TSH is that we're not seeing what the actual hormones from the thyroid are doing.

Emma Drady (10:57): So that's T3 and T4. And we are also not seeing if there is an autoimmune component of the thyroid condition either. And like we were sort of saying before that majority of these thyroid cases are autoimmune related. So we do want to see if that's part of their symptom picture or not. And so I've got a bit of a problem as well with the thyroid reference ranges for TSH. So I think there's a lot of naturopaths out there that feel the same in that these reference ranges are really broad and often patients will go undiagnosed with subclinical thyroid conditions or even just mild thyroid conditions for a really long time. And it's not until they fall outside these really broad ranges that they will even be picked up. So that's one reason why I don't like to just rely on the TSH.

Emma Drady (11:51): So ideally if they're going to go to the GP to get thyroid testing, they want to get TSH. They also want to get T4 and then they also want to get their thyroid antibodies checked so we can get a good picture of what's going on. There is also T3 which is the active thyroid hormone in our body, but that's usually not offered by the GP and it's not covered by Medicare. So that's the kind of thing that will need to be paid for through private testing. There's also reverse T3. That's another really helpful marker to see what's going on with the thyroid, but again, that's not covered by Medicare. So a lot of people won't have access to that unless they pay for it. And then to determine if there is an autoimmune condition, we'll need to see the presence of thyroid antibodies. And that's usually above the level of about 60.

Emma Drady (12:45): So a lot of people will have antibodies that are really, really high. But pathology labs actually cap the measurement of the thyroid antibodies. So depending on which lab you go to it's usually capped at about 1200 or 1300. So the patient might actually have thyroid antibodies that are, you know, 3000, but we won't know because it will be capped at that sort of 1300 amount. And that can be really tricky when we're trying to bring those numbers down because we can't actually see the change until it gets below the 1300 number. So it's really important to understand that and to sort of communicate that to your patients if you're treating them, because they can feel a bit disheartened if they're putting in all of this effort and it doesn't seem like they're having any results. They probably are. But we just haven't been able to see them yet because they haven't quite gone under that 1300 cap. So yeah, it's, it's really important to kind of get all of those things tested to understand what exactly is going on with the thyroid.

Wendy McLean (13:57): Absolutely. And, and how frequently would you do that testing if you did want to track someone's progress over time?

Emma Drady (14:06): With the antibodies, I know there's a lot of medical practitioners out there that don't think that the antibodies can change. It's, it's something that I've heard a lot from patients when they've gone to ask for these tests from their GPs, but it definitely can change, and I've seen it change. So I would sort of, depending on who the person is, I probably test every few months. I don't think it's necessary to test more often than that, unless there's someone that's in a very, very overactive state. And we really need to monitor it quite closely. Otherwise yeah, I would say every few months, maybe three months or so. Yes, probably enough.

Wendy McLean (14:49): So again, so testing is so important. And yeah. Sounds like it can be a little bit tricky as well, trying to understand what's going on with the person sitting in front of you if they're capping these tests. So what herbs and nutrients do you use in your or clinical practice to support people with these different thyroid disorders?

Emma Drady (15:16): So with nutrients selenium's one of my go-tos, especially for Hashimoto’s or Graves. It's really good for supporting thyroid function. And if anyone's ever on a budget, this is a really cost effective option for them because most selenium supplements out there are quite affordable. Depending on their blood work or urinary testing iodine can be used as well. But I wouldn't be using this for anyone that has antibodies, unless we did really, really low doses and we have the test results to show that they actually needed it. For those people, I usually would prefer a food as medicine type approach. So it might be something like seaweed and you really do need to test iodine levels before using it. I know there's a lot of practitioners out there that love big doses of iodine. I'm quite cautious with it. I know a lot of people have really immediate responses to it as well. So it might not necessarily be something they have to take long term.

Some of the other nutrients are what we sort of mentioned before that are really important for thyroid function like vitamin D and zinc and iron. They're all really, really important for the thyroid because it uses all of those different nutrients just to function. And they're also really good for the immune system too. So if there is that autoimmune component that can help with that as well.

The herbs that I go for are largely, they're largely dependent on their symptoms really. For underactive thyroid bacopa is one of my most commonly used, especially with those with brain fog. Or I also like Lion’s mane for brain fog as well. So usually one, one of the two, but bacopa does also help if there's that underactive component. It can be thyroid stimulating.  Rehmannia and Hemidesmus are two go-tos as well for the autoimmune patients. And Lemon balm. That's a big one for the overactive. And usually with those people, they need a lot of anxiety and sleep support as well. So any of the anxiolytics and sedatives, nervines, I’d be really loading them up on those too.

Wendy McLean (17:34): Yeah. So is that things like Passionflower and Lavender?

Emma Drady (17:40): Absolutely. Yep.

Wendy McLean (17:42): Yeah. yep. They're beautiful herbs. And of, of course you've mentioned food as medicine and I do love taking that approach as well. And are there other specific diet or lifestyle interventions that you recommend?

Emma Drady (17:59): Yeah. if there's any presence of autoimmunity, I am quite strict with gluten-free diets. And that's really an ongoing recommendation, so I want them to stay on that and they will really need to commit to it. But once they do, I've actually seen some really amazing results in a fairly fast turnaround, just from the gluten free diet. And it's a really nice cost-effective treatment option as well. You know, if, if someone didn't have much money to play with, I might just suggest going gluten free, then maybe eating daily some Brazil nuts for their selenium. I've actually got a Graves patient who's quite young. And she really didn't have any money to spend outside of just her consultation fee. So this is what we did just the gluten free diet and Brazil nuts. And she's made a huge improvement in just a few months.

Emma Drady (18:56): So food as medicine can be really powerful. But with, with majority of thyroid patients, particularly the underactive, I would suggest that they need to make sure they're getting enough protein in as well. And this can really support their fatigue and energy levels because often these underactive patients, they've got really low appetites. They're not eating a whole lot. And then they're feeling really fatigued. So we want to make sure they're actually getting enough fuel coming in the body. And sometimes these really simple suggestions can make the biggest difference. So I would sort of recommend, you know, things like the gluten-free diet, cutting down on alcohol and processed sugar, getting enough water, fueling your body with enough calories, rather than any sort of specific diets or protocols. Because from my experience, especially these people that are really fatigued or burnt out or are really struggling with their symptoms, they want something that's a little bit more sustainable and a little bit easier to follow rather than having to measure things out or check on charts that tell them what they can and can't eat. These underactive people specifically often are just so sluggish and fatigued, they can't really be bothered with really you know, specific protocols.

Wendy McLean Absolutely. Yeah, yeah, yeah. You do need to make it as easy for them as possible. Yeah. And, and supportive as well. And what about things like exercise? Are there any specific recommendations? I think you've mentioned these people have problems losing weight, but at the same time they're fatigued, so I imagine it must be quite difficult to be active.

Emma Drady (20:43): Yeah. It's really tricky to get daily movement in, but I just say to these people, even if it's just a 5, 10-minute stroll around the block to get you started while we work on increasing your energy, any sort of daily movement is going to be beneficial. Especially with, yeah, with the losing of the weight. I wouldn't be suggesting to any of these patients to go and sign up for high intensity. It's usually something like a walk around the block or if they like swimming, maybe a yoga class, something more gentle to bring them back up, because if we further deplete them, they're just not going to feel very good.

Wendy McLean (21:25): Yeah. Absolutely. And I think just, yeah, putting that you know, stress is a trigger I imagine of these conditions. So, you know, whether that be physical stress, like intense exercise, or emotional stress, so all very important sound recommendations. And you mentioned before that one of the risk factors is toxic exposure. Do you make any kind of recommendations about trying to reduce toxic exposures? Like things like reducing plastics or anything like that?

Emma Drady (21:56): Yeah, absolutely. I think doing a bit of an audit of the house can be a good step for a lot of people to do. And that comes down to looking at skincare products and I often sort of point them in the direction of a few different brands that I like or even websites where I know that they can find a few different things that will be safe for them to use. It comes down to cleaning products. A lot of people I often find that have these, these thyroid conditions seem to be in the middle of house renovations as well. The paint and all the toxins that come along with renovating and home improvements. We want to try and keep those to a bit of a minimum as well. That also comes down to buying good quality food as well. So if you can get organic, that's great. If not, you want to try and wash all of your fruit and your veg, all of your produce really, really well. And trying to be careful of where you source things like fish. Mercury can be a really big toxic exposure for a lot of people. And if anyone's got mercury fillings, I would sort of recommend talking to your dentist about whether there's the option of maybe having those removed. You would need to go to a specialty dentist to have that done cause not every dentist will do it properly. But yeah, things like mercury can definitely impact on the thyroid, just like radiation. So anyone that's had a lot of x-rays, a lot of scans and things over their life or has lived in an area with a lot of radiation exposure that can be a big trigger as well.

Wendy McLean (23:45): Yeah, absolutely. And do you recommend drinking or getting a water filter as well? Because I've read of the association between, or the competition between, fluoride and iodine in the thyroid.

Emma Drady (23:59): Yeah, absolutely. That's a big one that I do recommend, so water filters, you want to make sure that it filters out the fluoride. Because a lot of water filters out there don't. So there's a couple of brands available in Australia that do. So yeah, that's one thing that I would definitely recommend. I recommend that to most people, to be honest, because I think that it's, it's nice to have those things filtered out.

Wendy McLean (24:25): So I've heard that people can swing between the different states of an overactive and underactive thyroid. Do you see that in clinic and how do you manage that?

Emma Drady (24:36): Yeah. I have seen it from time to time. Most often I think it's a medication dosing issue. So from my experience I've seen it mainly in overactive thyroid patients who've been given Carbimazole or some other sort of thyroid medication to reduce their thyroid function, but then it sort of swung them into an underactive state. So what I recommend is firstly, to just go back to your GP and have a look at your medication dosage. Definitely don't stop taking the medication or change it up yourself. Because that's a cause for further swings. So when they start to feel better, I've seen some people, you know, they decide they don't want to take their medication anymore or maybe they want to just do it every couple of days.

And that really just creates a lot of instability in the thyroid. So you want to be quite careful with anyone who's, who's doing that and just really recommend not to muck around with their dosage. I've seen it swing in autoimmunity as well, but that's not very common. Some people will have antibodies that can cause both over and underactive symptoms. Or if someone has developed a hot nodule, which is a hormone producing nodule and they're an underactive patient and then they produce this nodule that can kind of swing them back and forth as well. So these people can be really quite difficult to manage because you've got to be really careful not to send them further into either direction. So my suggestion is to firstly go back to their GP and have a look at their dosage, but also create stability in their life and, and stability around everything. So food, sleep, exercise, their supplements, get everything into a routine. So they've got a lot of consistency. And, and then, you know, of course the gluten-free diet and the good nutrition and, and symptom management, but yeah, I just want everything to be quite consistent and routine. So that sort of gives them a bit of a baseline. So you just really need to be careful not to swing them either way.

Wendy McLean (26:49): Yeah. Yeah, absolutely. You've had so many great points here today and I'm just wondering if there's maybe two or three key takeaways that you would like our listeners to remember from all the things you've said today.

Emma Drady (27:05): Yeah. Well I think that the most important is to get the correct testing. It's really important that we don't just look at the TSH. It just doesn't give us enough information about what's going on. So you really want to look at the antibodies because like we sort of mentioned it is the main cause for thyroid conditions in, in this country. So without supporting the immune system the patient's just not really going to get the results that they deserve. So if the GP’s not going to do the full panel, get it done privately. And so you've got all the information before treating. I've seen so many people, you know, they've, they've been told they simply have an underactive thyroid, so they've been put on thyroxine for 10 years. And then finally they come through the door, we get the right testing, and it turns out they've got Hashimoto’s. So once we get onto that and they can finally start to see some results and I've even seen some will be able to drop their thyroxine medication over time, which is it's great for them.

Yeah. It's super rewarding. So I think, yeah, I get the right testing. So then you can treat the cause and treat the individual. They'd be my main tips.

Wendy McLean (28:22): That's wonderful. Yeah. That’s a really important point. So thank you so much for sharing your clinical insights today on thyroid disorders. You know, I've learned a lot as well. So it's been really, really insightful and so thanks, Emma.

Emma Drady (28:41): Thanks Wendy. Thanks for having me.

Wendy McLean (28:43): Yeah. And thanks for tuning into this episode today. We appreciate your support and feel free to leave us a review. We'd love to hear from you. Thank you.